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Fulltext Staple-line leak post primary sleeve gastrectomy. A two patient case series and literature review

Loo GH, Rajan R, Nik Mahmood NRK

Ann Med Surg (Lond), 2019 Aug;44:72-76.
PMID: 31321031 DOI: 10.1016/j.amsu.2019.06.014

There is an increasing trend in the number of bariatric surgeries performed worldwide, partly because bariatric surgery is the most effective treatment for morbid obesity. Sleeve gastrectomy (SG) remains the most common bariatric surgery procedure performed, representing more than 50% of all primary bariatric interventions. Major surgical complications of SG include staple-line bleeding, leaking, and stenosis. A leak along the staple-line most commonly occurs at the gastroesophageal junction (GOJ). From January 2018 to December 2018, our centre performed 226 bariatric procedures, of which, 97.8% were primary bariatric procedures. The mean age and BMI were 38.7±8.3 years and 44 kg/m2, respectively. Out of the 202 primary SG performed, we encountered two cases of a staple-line leak (0.99%). This is the first reported case series of SG leaks from the Southeast Asia region. A summary of their characteristics, clinical presentation, subsequent management, and the outcome is discussed. Based on the latest available evidence from the literature, several methods may decrease staple-line leaks in SG. These include the use of a bougie size greater than 40 Fr, routine use of methylene blue test during surgery, beginning transection at 2-6 cm from the pylorus, mobilising the fundus before transection, and staying away from the GOJ at the last firing. Other methods include the proper alignment of the staple-line, control of staple-line bleeding, and performing staple-line reinforcement. The management of a staple-line leak remains challenging due to limited systematic, evidence-based literature being available. Therefore, a tailored approach is needed to manage this complication.

Matched MeSH terms: Constriction, Pathologic
Fulltext Hair Thread Tourniquet Syndrome in an Infant: Emergency Exploration Saves Limbs

Kesu Belani L, Leong JF, Narin Singh PSG, Abdullah S

Cureus, 2019 Dec 13;11(12):e6377.
PMID: 31938655 DOI: 10.7759/cureus.6377

Hair thread tourniquet syndrome (HTTS) is a rare condition where fibres constrict around appendages causing ischaemia and necrosis. It is a sporadically reported condition, where almost all reported cases showed involvement of fingers, toes or genitalia. A significant number of the cases are infants aged two weeks to six months where it is attributed to the mother's excessive hair fall due to hormonal changes after delivery. We present a two-month-old infant who was irritable for the past two days with her left ring finger exhibiting an ischaemic constriction with no apparent insulting agent. She successfully treated surgically after we suspected an incomplete removal of hair thread in the emergency department. We would like to highlight the importance of a high index of suspicion in cases as such as early intervention saves the appendage.

Matched MeSH terms: Constriction
Fulltext Antinociceptive activity of methanolic extract of melastoma malabathricum l.leaves and mechanisms of action in experimentalanimals

Erman Shah Jaios, Suzanah Abdul Rahman, Mooi, Ching Siew, Arifah Abdul Kadir, Mohd Nasir Mohd Desa, Zainul Amirudin Zakaria

International Journal of Allied Health Sciences, 2017;1(1):1-1.
MyJurnal

Objectives/Research Problem:Melastoma malabathricum L., (Melastomaceae) is a medicinally important plant known as “Senduduk”. Traditionally, the leaves are used to relieve diverse pain-related ailments. Present study aims to examine the antinociceptive activity of methanolic extract of M. malabathricum (MEMM) leaves and its fractions via in vivo models of nociception.

Materials and Method: Extracts (100, 250, 500 mg/kg) were administered orally 60 minutes prior to subjection to the respective test, n=6/group. Evaluation of MEMM antinociceptive activity; chemically (acetic acid-induced abdominal constriction; ACT, formalin-induced paw licking test; FT) and thermally (hot plate test; HT) models of nociception and elucidation of mechanisms of action involved; role of opioid, vanilloid receptors, glutamatergic system and NO/cGMP pathway were determined. Continuously, MEMM, partitioned into three fractions: petroleum ether (PEMM), ethyl acetate (EAMM), and aqueous (AQMM) extracts and determine the most potent fraction. Therefore, experiment ED50 and its 95% confidence intervals (CI) values were conducted, and ACT was used to screen. Calculation, obtained, PEMM, the most effective was further used to assess the antinociceptive properties. Phytochemical screening, HPLC and GC-MS analysis were performed.

Results and Discussion: First stage, MEMM exhibited significant (P

Matched MeSH terms: Constriction
Fulltext Zerumbone Modulates α2A-Adrenergic, TRPV1, and NMDA NR2B Receptors Plasticity in CCI-Induced Neuropathic Pain In Vivo and LPS-Induced SH-SY5Y Neuroblastoma In Vitro Models

Chia JSM, Izham NAM, Farouk AAO, Sulaiman MR, Mustafa S, Hutchinson MR, et al.

Front Pharmacol, 2020;11:92.
PMID: 32194397 DOI: 10.3389/fphar.2020.00092

Zerumbone has shown great potential in various pathophysiological models of diseases, particularly in neuropathic pain conditions. Further understanding the mechanisms of action is important to develop zerumbone as a potential anti-nociceptive agent. Numerous receptors and pathways function to inhibit and modulate transmission of pain signals. Previously, we demonstrated involvement of the serotonergic system in zerumbone's anti-neuropathic effects. The present study was conducted to determine zerumbone's modulatory potential involving noradrenergic, transient receptor potential vanilloid type 1 (TRPV1) and N-methyl-D-aspartate (NMDA) receptors in chronic constriction injury (CCI)-induced in vitro and lipopolysaccharide (LPS)-induced SH-SY5Y in vitro neuroinflammatory models. von Frey filament and Hargreaves plantar tests were used to assess allodynia and hyperalgesia in the chronic constriction injury-induced neuropathic pain mouse model. Involvement of specific adrenoceptors were investigated using antagonists- prazosin (α1-adrenoceptor antagonist), idazoxan (α2-adrenoceptor antagonist), metoprolol (β1-adrenoceptor antagonist), ICI 118,551 (β2-adrenoceptor antagonist), and SR 59230 A (β3-adrenoceptor antagonist), co-administered with zerumbone (10 mg/kg). Involvement of excitatory receptors; TRPV and NMDA were conducted using antagonists capsazepine (TRPV1 antagonist) and memantine (NMDA antagonist). Western blot was conducted to investigate the effect of zerumbone on the expression of α2A-adrenoceptor, TRPV1 and NMDA NR2B receptors in CCI-induced whole brain samples of mice as well as in LPS-induced SH-SY5Y neuroblastoma cells. Pre-treatment with α1- and α2-adrenoceptor antagonists significantly attenuated both anti-allodynic and anti-hyperalgesic effects of zerumbone. For β-adrenoceptors, only β2-adrenoceptor antagonist significantly reversed the anti-allodynic and anti-hyperalgesic effects of zerumbone. β1-adrenoceptor antagonist only reversed the anti-allodynic effect of zerumbone. The anti-allodynic and anti-hyperalgesic effects of zerumbone were both absent when TRPV1 and NMDA receptors were antagonized in both nociceptive assays. Zerumbone treatment markedly decreased the expression of α2A-adrenoceptor, while an up-regulation was observed of NMDA NR2B receptors. Expression of TRPV1 receptors however did not significantly change. The in vitro study, representing a peripheral model, demonstrated the reduction of both NMDA NR2B and TRPV1 receptors while significantly increasing α2A-adrenoceptor expression in contrast to the brain samples. Our current findings suggest that the α1-, α2-, β1- and β2-adrenoceptors, TRPV1 and NMDA NR2B are essential for the anti-allodynic and antihyperalgesic effects of zerumbone. Alternatively, we demonstrated the plasticity of these receptors through their response to zerumbone's administration.

Matched MeSH terms: Constriction
Fulltext A successful case of endovascular treatment (EVT) of anterior communicating artery aneurysm associated with moyamoya disease

Sobri, M.A., Noorakmal, A., Razali, R.

Malaysian Journal of Medicine and Health Sciences, 2012;8(1):73-76.
MyJurnal

Saccular aneurysms associated with moyamoya disease are commonly located in the vertebrobasilar circulation. Anterior circulation aneurysm associated with moyamoya disease is uncommon and is usually treated by neurosurgical clipping. Objective: We report a succesful treatment using the endovascular approach in a case of ruptured anterior communicating artery aneurysm in unilateral moyamoya disease. Clinical Presentation: A 23 year old man presented with a 5 day history of headache, diplopia and fever. Computed Tomography (CT) scan and cerebral angiogram showed a bilobed anterior comunicating artery aneurysm. There was also severe M1 segment stenosis of the left middle cerebral artery with multiple collaterals, representing moyamoya vessels. Intervention: Treatment was done under general anesthesia and followed the standard practice for endovascular treatment. The aneurysm was occluded with three detachable platinum microcoils (Microplex®, Microvention®). Conclusion: Endovascular treatment can be a treatment option for ruptured anterior circulation saccular aneurysms associated with moyamoya disease.

Matched MeSH terms: Constriction, Pathologic
Fulltext Tandem Spinal Stenosis

Zulkefli, A., Ramanathan, R.

Malays Orthop J, 2010;4(1):46-49.
MyJurnal

A 42 years old gentleman presented with predominant low back pain associated with bilateral lower limb neurological deficit leading to an initial diagnosis of lumbar stenosis. Further history taking and examination revealed upper limb neurological deficit, and the lower limbs actually presented with upper motor neuron instead of lower motor neuron signs. Imaging studies confirmed the clinical findings with presence of both cervical and lumbar spinal stenosis. Twostage decompression procedures were performed at 6 monthintervals starting with cervical decompression. Postoperative improvement was noted on follow-up. This case highlights the importance of accurate diagnosis of cervical pathology for patients presenting with or referred for predominantly lumbar symptomology

Matched MeSH terms: Constriction, Pathologic
Fulltext Extracranial carotid stenosis after radiotherapy in nasopharyngeal carcinoma, a Malaysian study

Ng, Chong-Guan, Govindasamy, Krishnan Gopala, Tai, Sharon Mei-Ling, Tan, Chong-Tin, Mariyam Niyaz

Neurology Asia, 2013;18(2):143-151.
MyJurnal

Background and objectives: Radiation treatment in nasopharyngeal carcinoma (NPC) is known to be associated with increased prevalence of carotid stenosis. The objectives of the study was to determine the prevalence of radiation-induced extracranial carotid stenosis, plaque, carotid intima thickness (CIMT) in NPC patients; to explore whether the stenosis is due to direct effect of radiation rather than general tendency to atherosclerosis. Methods: This was a cross-sectional study conducted in the University Malaya Medical Centre from July 2011 to February 2012. The study subjects consisted of 47 NPC patients who were treated with radiation, and 47 healthy control. The patients and control had carotid duplex ultrasound and transcranial Doppler (TCD). Results: The mean age of the patients was 55.1 years, the time lapse from radiation was 76.7 ± 95.3 months. Internal carotid artery (ICA) and common carotid artery (CCA) stenosis of ≥50% was seen in 17.0% of patients vs 2.1 % of controls (p = 0.031), with 61.7% of patients and 19.1% of controls having plaque in ICA and CCA (p=0.004). CIMT was increased in 70.2% of patients and 44.7% of controls (p =0.022). Both the patient group and control had similar rate of intracranial stenosis of 12.8% in TCD.
Conclusion: Extracranial internal carotid artery is the most common site of stenosis following radiotherapy in NPC. This suggests that local trauma from irradiation is the most important factor in predisposition to atherosclerosis following radiation therapy.

Matched MeSH terms: Constriction, Pathologic
Fulltext Hemodynamic effects resulting from a common carotid to middle cerebral bypass with varying degrees of proximal internal carotid stenosis

Sheau, Fung Sia, Yu, Zhang, Yi, Qian, Khairul Azmi Abd Kadir, Hazman Mohd Nor, Morgan, Michael Kerin

Neurology Asia, 2014;19(3):241-247.
MyJurnal

Objective: To investigate the degree of stenosis of the internal carotid artery required for continuous blood flow in an interposition vein bypass to the middle cerebral artery. Methods: Computational fluid dynamics techniques were used to investigate a case of common carotid to middle cerebral artery brain bypass with varying degrees of internal carotid artery stenosis. Blood flow patterns across the patient-specific brain bypass were evaluated. Results: Simulation found that for cross section stenosis of less than 60%, no flow occurred in the bypass graft. Further narrowing of the internal carotid artery increased flow linearly within the bypass graft. There was significant energy loss and pressure gradient difference between the proximal and distal anastomosis sites of the bypass.
Conclusion: Computational fluid dynamics helps us to quantify the flow distribution, wall shear stress and pressure gradient in brain bypass surgery. The angle of the distal anastomosis had no effect on hemodynamic indices, allowing this consideration to be ignored in modeling. This modeling technique is useful to estimate the required degree of stenosis in the artery that is to be occluded to ensure sustained flow in the bypass. This will be of importance where there is staged surgery with a time interval between the bypass and the definitive internal carotid artery occlusion.

Matched MeSH terms: Constriction, Pathologic
Fulltext Undiagnosed bicuspid aortic valve: a silent danger

Ngow, H.A., Wan Khairina, W.M.N.

International Medical Journal Malaysia, 2012;11(2):45-48.
MyJurnal

The normal aortic valve has three leaflets, which are almost equal in size. A bicuspid aortic valve developed as a result of abnormal aortic cusp formation during early embryogenesis. Complications such as valvular stenosis or incompetence are well known. Delayed in identifying the congenital abnormality or the complications may cause morbidity and mortality. We report two cases of congestive cardiac failure as the results of undiagnosed bicuspid aortic valve with severe aortic incompetence. Both young men in their productive age without cardiac risk factors, were unfortunate to present too late. Although one of them was lucky to survive the ordeal, most late presentation ends up gravely. Aortic valve replacement can be offered if early detection is made. Those with severe disease at diagnosis may require a heart transplant.

Matched MeSH terms: Constriction, Pathologic
Fulltext A puzzling case of biliary stricture with calcified liver nodules

Leow, V.M., Faizah, M.S., Yang, K.F., Hasnan, M.N., Manisekar, S.S.

International Medical Journal Malaysia, 2013;12(2):79-82.
MyJurnal

Tuberculous (TB) biliary stricture with calcified liver nodules rendering obstructive jaundice is a rare clinical phenomenon. Recently, we encountered a young patient with obstructive jaundice who was investigated in a general hospital. He was sent to our hospital for subsequent management after undergoing a series of investigations and biliary stenting. The radiological imagings performed revealed multiple calcified lesions in the liver with proximal bile duct strictures. Blood investigations, tumor markers and tuberculous work up were not remarkable. Subsequently, he underwent laparotomy and biliary reconstruction. Postoperatively, he was discharged well. Histopathological examination of the hepatoduodenal nodes showed chronic infections and granulomatous lymphadenitis, suspicious of a mycobacterium infection.

Matched MeSH terms: Constriction, Pathologic
Fulltext Total pancreatectomy for diffuse pancreatic adenocarcinoma

Azlanudin, A., Razman, J.

Journal of Surgical Academia, 2011;1(1):39-41.
MyJurnal

A 64-year-old lady presented with a brief history of abdominal pain associated with obstructive jaundice. Endoscopic retrograde cholangiopancreaticography (ERCP) revealed a short segment stricture with contact bleeding and the brush cytology confirmed presence atypical cells. Ca 19.9 levels were markedly elevated. She was planned for a Whipple’s procedure but was instead subjected to a total pancreatectomy based on intraoperative findings of a diffusely hard and nodular pancreas. Histopathological examination confirmed our diagnosis of diffuse pancreatic adenocarcinoma. This rare presentation of a locally contained and fully resectable diffuse pancreatic adenocarcinoma is being discussed.

Matched MeSH terms: Constriction, Pathologic
Fulltext Coronary Artery Bypass Graft in a Young Adult, An Emerging Phenomenon: A Case Report.

Ramzisham, A.R.M., Joanna, O.S.M., Talal, A.R., Shahrulakmal, S., Maskon, O., Noorfaizan, S., et al.

International Medical Journal Malaysia, 2010;9(1):47-49.
MyJurnal

A 29-year-old, smoker, diabetic, hypertensive and hypercholesterolemic man was diagnosed of having severe coronary artery disease with a critical left main stem stenosis. On-pump coronary artery bypass graft surgery (CABG) was performed using conduits from the left internal mammary artery as well as the left radial artery and right saphenous vein which were both harvested endoscopically. He was discharged after a week of uneventful recovery. This case emphasizes on the best possible management of conduits selection, intraoperative myocardial protection and the risk factors modifi cation in achieving a long term graft patency and avoiding premature cardiac related death.

Matched MeSH terms: Constriction, Pathologic
Fulltext Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies

Tunku-Naziha TZ, Wan-Yuhana W, Hadizie D, Muhammad-Paiman, Abdul-Nawfar S, Wan-Azman WS, et al.

Malays Orthop J, 2017 Mar;11(1):12-17.
PMID: 28435568 MyJurnal DOI: 10.5704/MOJ.1703.005

The management of pink pulseless limbs in supracondylar fractures has remained controversial, especially with regards to the indication for exploration in a clinically well-perfused hand. We reviewed a series of seven patients who underwent surgical exploration of the brachial artery following supracondylar fracture. All patients had a non-palpable radial artery, which was confirmed by Doppler ultrasound. CT angiography revealed complete blockage of the artery with good collateral and distal run-off. Two patients were more complicated with peripheral nerve injuries, one median nerve and one ulnar nerve. Only one patient had persistent arterial constriction which required reverse saphenous graft. The brachial arteries were found to be compressed by fracture fragments, but were in continuity. The vessels were patent after the release of obstruction and the stabilization of the fracture. There was no transection of major nerves. The radial pulse was persistently present after 12 weeks, and the nerve activity returned to full function.

Matched MeSH terms: Constriction
Fulltext Stent migration after right ventricular outflow tract stenting in the severe cyanotic Tetralogy of Fallot case

Hayashi T, Akhtar S, Alwi M

Ann Pediatr Cardiol, 2017 6 2;10(2):206-208.
PMID: 28566833 DOI: 10.4103/0974-2069.205143

We report our experience with a stent migration after right ventricle outflow tract stenting and converted to patent ductus arteriosus stenting in Tetralogy of Fallot (TOF) with severe infundibular stenosis. Finally, the patient achieved to TOF repair, and the migrated stent was removed without any complication.

Matched MeSH terms: Constriction, Pathologic
Fulltext A Novel Restorative Pulmonary Valve Conduit: Early Outcomes of Two Clinical Trials

Morales DL, Herrington C, Bacha EA, Morell VO, Prodán Z, Mroczek T, et al.

Front Cardiovasc Med, 2020;7:583360.
PMID: 33748192 DOI: 10.3389/fcvm.2020.583360

Objectives: We report the first use of a biorestorative valved conduit (Xeltis pulmonary valve-XPV) in children. Based on early follow-up data the valve design was modified; we report on the comparative performance of the two designs at 12 months post-implantation. Methods: Twelve children (six male) median age 5 (2 to 12) years and weight 17 (10 to 43) kg, had implantation of the first XPV valve design (XPV-1, group 1; 16 mm (n = 5), and 18 mm (n = 7). All had had previous surgery. Based on XPV performance at 12 months, the leaflet design was modified and an additional six children (five male) with complex malformations, median age 5 (3 to 9) years, and weight 21 (14 to 29) kg underwent implantation of the new XPV (XPV-2, group 2; 18 mm in all). For both subgroups, the 12 month clinical and echocardiographic outcomes were compared. Results: All patients in both groups have completed 12 months of follow-up. All are in NYHA functional class I. Seventeen of the 18 conduits have shown no evidence of progressive stenosis, dilation or aneurysm formation. Residual gradients of >40 mm Hg were observed in three patients in group 1 due to kinking of the conduit (n = 1), and peripheral stenosis of the branch pulmonary arteries (n = 2). In group 2, one patient developed rapidly progressive stenosis of the proximal conduit anastomosis, requiring conduit replacement. Five patients in group 1 developed severe pulmonary valve regurgitation (PI) due to prolapse of valve leaflet. In contrast, only one patient in group 2 developed more than mild PI at 12 months, which was not related to leaflet prolapse. Conclusions: The XPV, a biorestorative valved conduit, demonstrated promising early clinical outcomes in humans with 17 of 18 patients being free of reintervention at 1 year. Early onset PI seen in the XPV-1 version seems to have been corrected in the XPV-2, which has led to the approval of an FDA clinical trial. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02700100 and NCT03022708.

Matched MeSH terms: Constriction, Pathologic
Fulltext Antinociceptive Activity of Methanol Extract of Muntingia calabura Leaves and the Mechanisms of Action Involved

Sani MH, Zakaria ZA, Balan T, Teh LK, Salleh MZ

Evid Based Complement Alternat Med, 2012;2012:890361.
PMID: 22611437 DOI: 10.1155/2012/890361

Muntingia calabura L. (family Elaeocarpaceae) has been traditionally used to relieve various pain-related ailments. The present study aimed to determine the antinociceptive activity of methanol extract of M. calabura leaves (MEMC) and to elucidate the possible mechanism of antinociception involved. The in vivo chemicals (acetic acid-induced abdominal constriction and formalin-, capsaicin-, glutamate-, serotonin-induced paw licking test) and thermal (hot plate test) models of nociception were used to evaluate the extract antinociceptive activity. The extract (100, 250, and 500 mg/kg) was administered orally 60 min prior to subjection to the respective test. The results obtained demonstrated that MEMC produced significant (P < 0.05) antinociceptive response in all the chemical- and thermal-induced nociception models, which was reversed after pretreatment with 5 mg/kg naloxone, a non-selective opioid antagonist. Furthermore, pretreatment with L-arginine (a nitric oxide (NO) donor), N(G)-nitro-L-arginine methyl esters (L-NAME; an inhibitor of NO synthase (NOS)), methylene blue (MB; an inhibitor of cyclic-guanosine monophosphate (cGMP) pathway), or their combination also caused significant (P < 0.05) change in the intensity of the MEMC antinociception. In conclusion, the MEMC antinociceptive activity involves activation of the peripheral and central mechanisms, and modulation via, partly, the opioid receptors and NO/cGMP pathway.

Matched MeSH terms: Constriction
Fulltext Cerebral CT angiography and CT perfusion in acute stroke detection: a systematic review of diagnostic value

Sabarudin A, Subramaniam C, Sun Z

Quant Imaging Med Surg, 2014 Aug;4(4):282-90.
PMID: 25202664 DOI: 10.3978/j.issn.2223-4292.2014.07.10

The purpose of this study was to analyse the diagnostic value of cerebral CT angiography (CTA) and CT perfusion (CTP) examinations in the detection of acute stroke based on a systematic review of the current literature. The review was conducted based on searching of seven databases for articles published between 1993 and 2013. Diagnostic value in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy was analysed from 21 articles which were found to meet selection criteria. The mean sensitivity, specificity, PPV, NPV and accuracy for CTA were significantly higher than those for CTP with 83.2% (95% CI: 57.9-100.0%), 95.0% (95% CI: 74.4-100%), 84.1% (95% CI: 50.0-100%), 97.1 (95% CI: 94.0-100%) and 94.0% (95% CI: 83.0-99.0) versus 69.9% (95% CI: 20.0-97.0%), 87.4 (95% CI: 61.0-100.0%), 76.4% (95% CI: 48.0-95.4%), 78.2% (95% CI: 55.8-93.9%) and 89.8% (95% CI: 75.7-97.1%), respectively. This analysis shows that CTA has high diagnostic value in detecting high degree of cerebral arterial stenosis (>70%) whereas CTP provides high specificity in the detection of ischemia and infarct tissue of brain.

Matched MeSH terms: Constriction, Pathologic
Fulltext Iatrogenic aspiration of custom-made keel: a case report

Sharouny H, Omar RB

Iran Red Crescent Med J, 2014 Dec;16(12):e17066.
PMID: 25763237 DOI: 10.5812/ircmj.17066

INTRODUCTION: Laryngeal stenosis has various causes and treatment options. Endoscopic resection of the stenotic part with CO2 laser is one of the treatment options of laryngotracheal stenosis. Keels are useful for preventing adhesion formation, restenosis and web formation, which may happen during the later stage. They can be put in place either via the endoscopic approach or through a micro thyroidotomy and are held in place with a heavy suture through cricothyroid and thyrohyoid membranes. They are left in place for two to four weeks, and then removed through the endoscopic approach under general anesthetics.
CASE PRESENTATION: We report on a case of anterior glottis stenosis with keel aspiration for two weeks, after endoscopic CO2 laser resection of the stenotic section and keel placement. The patient was admitted to our center, where bronchoscopy was performed and the keel was removed. A new custom-made silastic keel was properly placed in raw areas and fixed to the skin with suture through the cricothyroid and thyrohyoid membranes. The keel was removed three weeks later.
CONCLUSIONS: Endoscopic keel placement should be done with heavy suture through cricothyroid and thyrohyoid membranes. Surgeons should suture the keel to the anterior laryngeal wall with specially designed Lichtenberger's needle-carriers to prevent complications such as keel aspiration, adhesion formation and imposing a second trip under general anesthetics, which put the patient at increased risk. The false vocal cord microflaps, as biological keels and a relatively new method may replace silastic keel placement in the future.

Matched MeSH terms: Constriction, Pathologic
Fulltext The short-term outcome of laser endoureterotomy for ureteric stricture

Han PK, Rohan M, Bujang MA

Med J Malaysia, 2013 Jun;68(3):222-6.
PMID: 23749010 MyJurnal

With the advent of new technology, the treatment for ureteric stricture has moved from open surgery to endoscopic procedures. Our goals were to review and determine the prognostic factors for success of laser endoureterotomy for ureteric stricture. This is a cross sectional study for all cases that underwent laser endoureterotomy in a single centre from 2002 to 2009. Standard treatment in this centre utilizes holmium laser. The fiber used was 365nm, setting as 1J and frequency 8 Hz; power output 8 W. Confirmation of adequacy of incision wss by either visualization of extra-ureteric fat or extravasations of contrast on fluoroscopic imaging. Success or recurrence of the endoureterotomy was confirmed objectively with evidence of improvement from imaging. Of these 77 patients, 42 cases (61.8%) of the strictures were from upper ureter. Eight cases (11.7%) of mid-ureteric while lower ureter had 18 cases (26.5%). Length of stricture has been grouped into two groups; Short (<1cm) and long (≥1cm) and their distributions were 47.1% and 26.5% respectively. Follow-up duration ranged from six months to 88 months with an average of 19.6 months. Success rate was 76.5% (52 patients) while 16 patients (23.5%) developed recurrence. Stone disease, positive presenting symptoms and short length of the stricture were identified as variables with good predictor. This study achieved a 76.5% of success rate for this treatment modality for benign ureteric stricture in wellselected patients. Success is more likely if patient is symptomatic (earlier treatment) and previous stone disease present as a risk factor.
Study site: Hospital Selayang, Kuala Lumpur

Matched MeSH terms: Constriction, Pathologic
Fulltext Stenting of vertical vein in an infant with obstructed supracardiac total anomalous pulmonary venous drainage

Lim WK, Leong MC, Samion H

Ann Pediatr Cardiol, 2016 5 24;9(2):183-5.
PMID: 27212859 DOI: 10.4103/0974-2069.173549

A 1.7 kg infant with obstructed supracardiac total anomalous pulmonary venous drainage (TAPVD) presented with severe pulmonary hypertension secondary to vertical vein obstruction. The child, in addition, had a large omphalocele that was being managed conservatively. The combination of low weight, unoperated omphalocele, and severe pulmonary hypertension made corrective cardiac surgery very high-risk. Therefore, transcatheter stenting of the stenotic vertical vein, as a bridge to corrective surgery was carried out. The procedure was carried out through the right internal jugular vein (RIJ). The stenotic segment of the vertical vein was stented using a coronary stent. After procedure, the child was discharged well to the referred hospital for weight gain and spontaneous epithelialization of the omphalocele. Stenting of the vertical vein through the internal jugular vein can be considered in very small neonates as a bridge to repair obstructed supracardiac total anomalous venous drainage.

Matched MeSH terms: Constriction, Pathologic

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